A comparative study of family functioning among Vietnamese and Cambodian refugees

Family interventions in traumatized immigrants and refugees: A systematic review

The importance of the family as a unit in the aftermath of trauma necessitates the use of family interventions among immigrants and refugees. While abundant clinical material suggests that family-based trauma interventions are applicable across cultures, very little is known about the extent to which family treatment modalities are effective for immigrants and refugees. We conducted a systematic review of intervention studies that have been designed or modified specifically for traumatized immigrant and refugee families. The terms "trauma," "family," and "immigrants/refugees/culture" were used along with different terms for "intervention." Studies with no research methodology were excluded. Only 6 experimental studies met our inclusion criteria; 4 of them describe school-based interventions and 2 present multifamily support groups. The shortage of research in this area does not allow clear conclusions about the effectiveness of family interventions for traumatized immigrants or refugees. The complexity of employing methodologically rigorous research in small communities is discussed. Future trials should go beyond the individualistic approach and focus on posttraumatic stress disorder to address family-level processes, such as family relationship, communication, and resilience.

Disclosure and silencing: A systematic review of the literature on patterns of trauma communication in refugee families

This systematic review aimed to explore the effects of different degrees of parental disclosure of traumatic material from the past on the psychological well-being of children in refugee families. A majority of studies emphasize the importance of the timing of disclosure and the manner in which it takes place, rather than the effects of open communication or silencing strategies per se. A pattern emerged in which the level of parental disclosure that promotes psychological adjustment in refugee children depends on whether the children themselves have been directly exposed to traumatic experiences, and whether the children are prepubescent or older. The process of trauma disclosure is highly culturally embedded. Future research needs to address the culturally shaped variations in modulated disclosure and further explore how modulated disclosure can be facilitated in family therapy with traumatized refugee families.

Trauma, exile and mental health in young refugees

OBJECTIVE

To review evidence of trauma and exile-related mental health in young refugees from the Middle East.

METHOD

A review of four empirical studies: i) a qualitative study of 11 children from torture surviving families, ii) a cohort study of 311 3-15-year-old asylum-seeking children, iii) a qualitative study of 14 members of torture surviving families and iv) a follow-up study of 131 11-23-year-old refugees.

RESULTS

The reactions of the children were not necessarily post-traumatic stress disorder specific. Seventy-seven per cent suffered from anxiety, sleep disturbance and/or depressed mood at arrival. Sleep disturbance (prevalence 34%) was primarily predicted by a family history of violence. At follow-up, 25.9% suffered from clinically relevant psychological symptoms. Traumatic experiences before arrival and stressful events in exile predicted internalizing behaviour, witnessing violence and frequent school changes in exile predicted externalizing behaviour. School participation, Danish friends, language proficiency and mother's education predicted less long-term psychological problems.

CONCLUSION

Psychological problems are frequent in refugee children, but the extents are reduced over time in exile. Traumatic experience before arrival is most important for the short-term reaction of the children while aspects of life in exile are important for the children's ability to recover from early traumatization.

The familial influence of loss and trauma on refugee mental health: a multilevel path analysis

Although the impact of human rights violations on the mental health of refugees has been well documented, little is known about these effects at a family level. In this study the authors examined the relationships among loss, trauma, and mental health at the individual and family levels in resettled Mandaean refugees (N = 315). Trauma, loss, posttraumatic stress disorder, depression, complicated grief, and mental health-related quality of life were assessed. A multilevel path analysis revealed that loss and trauma significantly impacted on psychological outcomes at both the individual and family levels. Effect sizes ranged from .21 to .68 at the individual level, and .38 to .99 at the family level, highlighting the importance of the family when considering the psychological impact of refugee-related trauma.

Acculturation gaps in Vietnamese immigrant families: Impact on family relationships

Vietnamese immigrants in the United States face acculturation challenges involving the individual, family, and community. Experts suggest that immigrant family members acculturate at different rates resulting in an acculturation gap, which negatively influences family adjustment. In this study we examined the degree and patterns of acculturation differences between 104 first generation immigrant Vietnamese adolescents and their parents, and whether acculturation gap affected family relationships. Operationalizing the "gap" as both absolute value of differences in acculturation and interactions of parent and adolescent acculturation levels, we examined the impact of such gaps in Vietnamese and American language, identity, and behavioral acculturation on family relationships. Results revealed that family cohesion and satisfaction were predicted by gaps in Vietnamese identity acculturation, but not by gaps in other acculturation domains.

Better mental health in children of Vietnamese refugees compared with their Norwegian peers--a matter of cultural difference?

BACKGROUND

There are conflicting results on whether immigrant children are at a heightened risk of mental health problems compared with native youth in the resettlement country. THE OBJECTIVE OF THE STUDY: To compare the mental health of 94 Norwegian-born children from a community cohort of Vietnamese refugees, aged 4 - 18 years, with that of a Norwegian community sample.

METHODS

The SDQ was completed by two types of informants; the children's self-reports, and the parents' reports, for comparison with Norwegian data from the Health Profiles for Children and Youth in the Akershus study.

RESULTS

The self-perceived mental health of second-generation Vietnamese in Norway was better than that of their Norwegian compatriots, as assessed by the SDQ. In the Norwegian-Vietnamese group, both children and parents reported a higher level of functioning.

CONCLUSION

This surprising finding may result from the lower prevalence of mental distress in Norwegian-Vietnamese children compared with their Norwegian peers, or from biased reports and cultural differences in reporting emotional and behavioural problems. These findings may represent the positive results of the children's bi-cultural competencies.

Types, meanings and ambivalence in intergenerational exchanges among Cambodian refugee families in the United States

This article aims to answer the following question: how have refugee families in the United States (US) modified attitudes and behaviours surrounding intergenerational exchanges within the context of filial piety? This research reports on one 31-member extended family in a community of Cambodian refugee families living along the Gulf of Mexico coast. The family members in this study have changed types, found new meanings in, and are often ambivalent about, intergenerational exchanges. Moreover, they have held onto those aspects of Cambodian culture that were considered essential, such as filial piety and elder reverence, while adapting and redefining types and meanings of intergenerational exchanges the better to reflect their current lives in the United States. These findings illuminate ways in which changed life circumstances and cultural transitions shaped attitudes, preferences and behavioural patterns associated with intergenerational exchanges. The findings also show how and why refugee families have negotiated and modified their beliefs and behaviours surrounding intergenerational exchanges in the context of massive social and cultural disruption.

Multicultural mental health services

Oregon has a significant Indochinese minority community. Seen through the eyes of this group, few of the difficulties minorities encounter when seeking culturally competent services have changed under the Oregon Health Plan.

Vietnamese parental perceptions of child and adolescent mental illness

OBJECTIVES

To determine the symptoms and behaviors in children which are considered psychopathological by Vietnamese parents, to identify professionals and agencies in the community whom Vietnamese parents would consult if their child had a mental illness, and to determine Vietnamese parents' awareness of existing community mental health services.

METHOD

Structured interviews were conducted with a randomized community sample of 283 Vietnamese parents in Perth, Australia. Parents were asked to identify the symptoms and behaviors they considered psychopathological in children, where they would turn for help with a mentally ill child, their knowledge of community mental health services for children, and their understanding of the causes of child psychiatric disorders.

RESULTS

Vietnamese parents identified psychotic symptoms, disorientation, and suicidal thoughts and behavior as psychopathological. They preferentially endorsed Western-style treatment approaches but had little awareness of existing community mental health services for children. A biological/chemical imbalance, traumatic experiences, and a metaphysical/spiritual imbalance were identified as the most likely causes of child mental illness.

CONCLUSIONS

Despite a different cultural tradition, Vietnamese parents appear open to services provided by Western-trained mental health professionals. Their very limited awareness of child and adolescent mental health services in the community, however, may severely limit their utilization of such services.

Generational differences in psychosocial adaptation and predictors of psychological distress in a population of recent Vietnamese immigrants

While first-wave Vietnamese immigrants adapted well to life in the United States, subsequent immigrants have had greater adjustment difficulties, including more evidence of psychological distress. This study aimed to analyze psychosocial adaptation differences among three generations of recent Vietnamese immigrants, as well as to examine predictors of mental distress in the sample as a whole. A community sample of 184 recent Vietnamese immigrants, categorized as either elderly, middle-aged, or young adults, was assessed for levels of psychological distress, including depression, anxiety, and PTSD, as well as family conflict, dissatisfaction with life in the U.S., acculturation and biculturalism, social support, coping, and premigratory stressors. Young Vietnamese adults were most acculturated, most bicultural, and reported themselves as healthiest and least depressed. They were most often working, least often on welfare, and had the highest family income. However, they also reported most dissatisfaction with their current lives in the U.S. and most family conflict. Regression analysis explaining approximately one-quarter of the variance in mental distress implicated current dissatisfaction with and lack of adjustment of life in the United States, as well as greater acculturation and increased family conflict. Although young adults scored significantly higher than other generations on most of the risk factors for psychological distress, they appeared to be buffered against poorer mental health outcomes by factors of generation and perceived positive overall well-being. In terms of testing a predictive model of psychological distress, this study found current adjustment factors significantly more important in determining mental health outcomes than premigratory stressors such as war-related traumas.

Depression and anxiety among Cambodian refugee women in France and the United States

This study reports on Cambodian refugee data related to signs symptomatic of depression and anxiety, the tendency to worry or ruminate over past events (a culture-bound syndrome called "Khoucherang"), and differences that might be influenced by social system and cultural practice. A sample consisting of 155 women of Cambodian national origin were interviewed in their homes in the USA and France. Answers to the research questions were collected by a focused interview to elicit demographic information, and the Hopkins Symptom Checklist (HSCL) in the Cambodian language to elicit depression and anxiety scores. Women residing in France (87%) were significantly more likely to show signs symptomatic of depression than women residing in the USA (65%). Women in the study reported about three times as much depression as the average American woman. Large numbers of women residing in both countries were symptomatic of anxiety (82% on average). Both groups experienced extreme symptoms of the culture-bound syndrome, "Khoucherang," and appeared to be strongly influenced by the different social systems of the two countries.